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Eichel VM, Last K, Brühwasser C, von Baum H, Dettenkofer M, Götting T, Grundmann H, Güldenhöven H, Liese J, Martin M, Papan C, Sadaghiani C, Wendt C, Werner G, Mutters NT. Epidemiology and outcomes of vancomycin-resistant enterococcus infections: a systematic review and meta-analysis. J Hosp Infect 2023; 141:119-128. [PMID: 37734679 DOI: 10.1016/j.jhin.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however, remains fragmented. We aimed to summarize recent studies on VRE epidemiology and outcomes in hospitals, long-term-care facilities (LTCFs) and nursing homes worldwide based on current epidemiological reports. We searched MEDLINE/PubMed, the Cochrane Library, and Web of Science for observational studies, which reported on VRE faecium and faecalis infections in in-patients published between January 2014 and December 2020. Outcomes were incidence, infection rate, mortality, length of stay (LOS), and healthcare costs. We conducted a meta-analysis on mortality (PROSPERO registration number: CRD42020146389). Of 681 identified publications, 57 studies were included in the analysis. Overall quality of evidence was moderate to low. VRE incidence was rarely and heterogeneously reported. VRE infection rate differed highly (1-55%). The meta-analysis showed a higher mortality for VRE faecium bloodstream infections (BSIs) compared with VSE faecium BSIs (risk ratio, RR 1.46; 95% confidence interval (CI) 1.17-1.82). No difference was observed when comparing VRE faecium vs VRE faecalis BSI (RR 1.00, 95% CI 0.52-1.93). LOS was higher in BSIs caused by E. faecium vs E. faecalis. Only three studies reported healthcare costs. In contrast to previous findings, our meta-analysis of included studies indicates that vancomycin resistance independent of VRE species may be associated with a higher mortality. We identified a lack of standardization in reporting outcomes, information regarding healthcare costs, and state-of-the-art microbiological species identification methodology, which may inform the set-up and reporting of future studies.
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Affiliation(s)
- V M Eichel
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany
| | - K Last
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
| | - C Brühwasser
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany; Infection Prevention and Hospital Hygiene, University Hospital Innsbruck, Innsbruck, Austria
| | - H von Baum
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | | | - T Götting
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Grundmann
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Güldenhöven
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - J Liese
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - M Martin
- Institute for Infection Prevention and Hospital Hygiene, SLK-Kliniken Heilbronn GmbH, Germany
| | - C Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - C Sadaghiani
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - C Wendt
- MVZ Labor Dr. Limbach, Department of Hygiene, Heidelberg, Germany
| | - G Werner
- Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci (NRC), Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - N T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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Doss Susai Backiam A, Duraisamy S, Karuppaiya P, Balakrishnan S, Chandrasekaran B, Kumarasamy A, Raju A. Antibiotic Susceptibility Patterns and Virulence-Associated Factors of Vancomycin-Resistant Enterococcal Isolates from Tertiary Care Hospitals. Antibiotics (Basel) 2023; 12:981. [PMID: 37370300 DOI: 10.3390/antibiotics12060981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
This study explored the prevalence of multi-drug resistance and virulence factors of enterococcal isolates obtained from various clinical specimens (n = 1575) including urine, blood, pus, tissue, catheter, vaginal wash, semen, and endotracheal secretions. Out of 862 enterococcal isolates, 388 (45%), 246 (29%), 120 (14%), and 108 (13%) were identified as Enterococcus faecalis, Enterococcus faecium, Enterococcus durans, and Enterococcus hirae, respectively, using standard morphological and biochemical methods. The antibiotic resistance profile of all these enterococcal isolates was checked using the disc diffusion technique. High-level resistance was observed for benzylpenicillin (70%) and vancomycin (43%) among E. faecalis and E. faecium isolates, respectively. This study also revealed the prevalence of 'multi-drug resistance (resistant to 3 antibiotic groups)' among the vancomycin-resistant enterococcal strains, and this was about 11% (n = 91). The virulence determinants associated with vancomycin resistance (VR) were determined phenotypically and genotypically. About 70 and 39% of E. faecalis and E. faecium isolates showed to be positive for all four virulence factors (gelatinase, protease, hemolysin, and biofilm). Among the several virulence genes, gelE was the most common virulence gene with a prevalence rate of 76 and 69% among E. faecalis and E. faecium isolates, respectively. More than 50% of VRE isolates harbored other virulence genes, such esp, asa, ace, and cylA. Similarly, the majority of the VR enterococcal isolates (n = 88/91) harbored vanA gene and none of them harbored vanB gene. These results disclose the importance of VR E. faecalis and E. faecium and the associated virulence factors involved in the persistence of infections in clinical settings.
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Affiliation(s)
- Arockia Doss Susai Backiam
- Department of Microbiology, Vivekanandha College of Arts and Science for Women (Autonomous), Tiruchengode 637303, India
| | - Senbagam Duraisamy
- Department of Marine Biotechnology, Bharathidasan University, Tiruchirappalli 620024, India
| | - Palaniyandi Karuppaiya
- Department of Marine Biotechnology, Bharathidasan University, Tiruchirappalli 620024, India
| | - Senthilkumar Balakrishnan
- Division of Biological Sciences, Tamil Nadu State Council for Science and Technology, Chennai 600025, India
| | - Balaji Chandrasekaran
- Irma Lerma Rangel School of Pharmacy, Texas A & M University, Kingsville, TX 77843, USA
| | - Anbarasu Kumarasamy
- Department of Marine Biotechnology, Bharathidasan University, Tiruchirappalli 620024, India
| | - Amutha Raju
- Department of Biotechnology, Periyar University Centre for Post Graduate and Research Studies, Dharmapuri 635205, India
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Ma A, Dong M, Cheng J, Liao X, Dong W, Liu C, Hu C, Yang J, Kang Y. Clinical efficacy and safety of linezolid in intensive care unit patients. JOURNAL OF INTENSIVE MEDICINE 2022; 3:65-72. [PMID: 36789359 PMCID: PMC9923966 DOI: 10.1016/j.jointm.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/24/2022] [Accepted: 05/14/2022] [Indexed: 10/17/2022]
Abstract
Background To characterize the population of critically ill patients and infections treated with linezolid in the intensive care unit (ICU), and to evaluate the clinical efficacy and safety of linezolid therapy. Methods This multi-center, observational, real-world study was conducted across 52 hospitals between June 9, 2018, and December 28, 2019. Patients who met the following inclusion criteria were included: (1) admitted to the ICU, (2) of any age group, and (3) having a clinical or laboratory diagnosis of a Gram-positive bacterial infection. Clinical efficacy was categorized as success (cured or improved), failed, or non-evaluable. Adverse events and serious adverse events were recorded during treatment. Results A total of 366 ICU patients who met the inclusion criteria were evaluated. Linezolid was used as second- and first-line treatment in 232 (63.4%) and 134 (36.6%) patients, respectively. The most common isolated strain was Staphylococcus aureus (methicillin-resistant Staphylococcus aureus: n=37/119, 31.1%; methicillin-susceptible Staphylococcus aureus: n=15/119, 12.6%); this was followed by Enterococci (vancomycin-resistant Enterococci: n=8/119, 6.7%; vancomycin-susceptible Enterococci: n=11/119, 9.2%) and Streptococcus pneumoniae (multidrug-resistant: n=4/119, 3.4%; non-multidrug resistant: n=2/119, 1.7%). The main infection sites where pathogens were detected included the lung (n=216/366, 59.6%), skin and soft tissue (n=104/366, 28.4%), and blood (n=50/366, 13.7%). Clinical success was achieved in 301 (82.2%) patients; 34 (9.3%) were cured and 267 (73.0%) improved; treatment failure and non-evaluable outcomes were observed in 29 (7.9%) in 36 (9.8%) patients, respectively. Linezolid-related adverse events were reported in 8 (2.2%) patients. No treatment-related serious adverse events were reported. Conclusions Based on real-world results, linezolid was found to be effective and safe in the treatment of Gram-positive bacterial infections in critically ill patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Jing Yang
- Corresponding authors: Jing Yang and Yan Kang, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
| | - Yan Kang
- Corresponding authors: Jing Yang and Yan Kang, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
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Farias BOD, Bianco K, Nascimento APA, Gonçalves de Brito AS, Moreira TC, Clementino MM. Genomic Analysis of Multidrug-Resistant Enterococcus faecium Harboring vanA Gene from Wastewater Treatment Plants. Microb Drug Resist 2022; 28:444-452. [PMID: 35172112 DOI: 10.1089/mdr.2021.0254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The emergence of vancomycin-resistant Enterococcus faecium (Efm) harboring vanA gene and multidrug-resistant determinants is a relevant public health concern. It is an opportunistic pathogen responsible for nosocomial infections widely distributed in the environment, including wastewater treatment plants (WWTPs). Our study addresses a genomic investigation of vanA-carrying Efm from WWTPs in Brazil. Samples from five WWTPs supplied with sewage from different sources were evaluated. Here we present whole-genome sequencing of eight vanA-Efm isolates performed on Illumina MiSeq platform. All these isolates presented multidrug-resistant profile, and five strains were from treated wastewater. Multiple antimicrobial resistance genes (ARGs) were found, such as aph(3')-IIIa, ant(6')-Ia, erm(B), and msrC, some of them being allocated in plasmids. The virulence profile was predominantly constituted by efaAfm and acm genes and all isolates, except for one, were predicted as human pathogens. Multilocus sequence typing analysis revealed a new allele and five different STs, three previously described (ST32, ST168, and ST253) and two novel ones (ST1893 and ST1894). Six strains belonged to CC17, often associated with hospital outbreaks. As far as our knowledge, no genomic studies of vanA-Efm recovered from WWTPs revealed isolates belonging to CC17 in Brazil. Therefore, our findings point to the environmental spread of Efm carrying multiple ARGs.
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Affiliation(s)
- Beatriz Oliveira de Farias
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde-Avenida Brasil, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Kayo Bianco
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde-Avenida Brasil, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Ana Paula Alves Nascimento
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde-Avenida Brasil, Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Thais Costa Moreira
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde-Avenida Brasil, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Maysa Mandetta Clementino
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde-Avenida Brasil, Rio de Janeiro, Rio de Janeiro, Brasil
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Reinseth IS, Ovchinnikov KV, Tønnesen HH, Carlsen H, Diep DB. The Increasing Issue of Vancomycin-Resistant Enterococci and the Bacteriocin Solution. Probiotics Antimicrob Proteins 2021; 12:1203-1217. [PMID: 31758332 PMCID: PMC8613153 DOI: 10.1007/s12602-019-09618-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Enterococci are commensals of human and other animals’ gastrointestinal tracts. Only making up a small part of the microbiota, they have not played a significant role in research, until the 1980s. Although the exact year is variable according to different geographical areas, this was the decade when vancomycin-resistant enterococci (VRE) were discovered and since then their role as causative agents of human infections has increased. Enterococcus faecium is on the WHO’s list of “bacteria for which new antibiotics are urgently needed,” and with no new antibiotics in development, the situation is desperate. In this review, different aspects of VRE are outlined, including the mortality caused by VRE, antibiotic resistance profiles, animal-modeling efforts, and virulence. In addition, the limitations of current antibiotic treatments for VRE and prospective new treatments, such as bacteriocins, are reviewed.
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Affiliation(s)
- Ingvild S Reinseth
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway
| | - Kirill V Ovchinnikov
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway
| | - Hanne H Tønnesen
- Section of Pharmaceutics and Social Pharmacy, Department of Pharmacy, University of Oslo, P.O. Box 1068 Blindern, 0316, Oslo, Norway
| | - Harald Carlsen
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway
| | - Dzung B Diep
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway.
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Characterization of Clinical Isolates of Enterococci with Special Reference to Glycopeptide Susceptibility at a Tertiary Care Center of Eastern Nepal. Int J Microbiol 2019; 2019:7936156. [PMID: 31354832 PMCID: PMC6636468 DOI: 10.1155/2019/7936156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/04/2019] [Accepted: 05/26/2019] [Indexed: 01/15/2023] Open
Abstract
Background Enterococci, once considered as a harmless commensal of intestine, have now emerged as medically important pathogens and are associated with both community-acquired and nosocomial infections. They bear the potential to exhibit resistance against all commonly used antibiotics either by inherent or acquired mechanism, posing a therapeutic challenge. Objectives This study aimed to characterize enterococci up to the species level and study their antibiogram with special regard to vancomycin. Methods A descriptive cross-sectional study was conducted in the Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, from February to May 2017. A total of 91 enterococcal isolates recovered from clinical specimens were investigated in this study. Their identification and speciation were done according to standard microbiological guidelines. Kirby–Bauer disc diffusion technique was used to study antimicrobial susceptibility pattern, whereas minimum inhibitory concentration of vancomycin was determined by the agar dilution method, with reference to Clinical and Laboratory Standards Institute guidelines. Results Seven different species of enterococci were isolated, E. faecalis and E. faecium accounting about 45% each. The other species encountered were E. avium, E. cecorum, E. dispar, E. durans, and E. Conclusions Enterococcus faecalis and E. faecium were the predominant species in causing enterococcal infections. The alarming rise in prevalence of vancomycin and multidrug resistance strains warrants immediate, adequate, and efficient surveillance program to prevent and control its spread.
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Molecular epidemiology of vancomycin resistant enterococci in a tertiary care hospital in Saudi Arabia. Microb Pathog 2016; 97:79-83. [PMID: 27247096 DOI: 10.1016/j.micpath.2016.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
AIM Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infections with high mortality and morbidity. There is limited data on the molecular characterization of VRE in Saudi Arabia. This study was carried out to investigate the premise that a shift in VRE epidemiology is occurring in our setting. METHODS Enterococcus species identification and susceptibility testing plus VRE phenotypic confirmation by vancomycin and teicoplanin E-test were carried out. Vancomycin resistance genes were detected by PCR. Strain typing was conducted using PFGE. RESULTS Among the strains of Enterococcus spp. investigated in this study, 17 (4.5%) were VRE. With the exception of one isolate from rectal swab, all others were clinical specimens with blood being the commonest source (n = 11; 64.7%), followed by urine (n = 3; 17.6%). The 17 VRE isolates were Enterococcus faecium (n/N = 13/17) and Enterococcus gallinarum (n/N = 4/17). Among E. faecium isolates, vanA(+)/vanB(+) (n/N = 8/13; 62%) exhibiting VanB phenotype were predominant. One of the five vanA(+)E. faecium isolates exhibited a VanB phenotype indicative of vanA genotype-VanB phenotype incongruence. E. gallinarum isolates exhibited a Van C phenotype although two were vanA(+)/vanC1(+). PFGE revealed a polyclonal distribution with eight pulsotypes. CONCLUSION These findings indicate an evolving VRE epidemiology with vanA(+)/vanB(+) isolates and vanA genotype-VanB phenotype incongruence isolates, which were previously described as colonizers, are now causing clinical infection.
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Mahabeer Y, Lowman W, Govind CN, Swe-Swe-Han K, Mlisana KP. First outbreak of vancomycin-resistant Enterococcus in a haematology unit in Durban, South Africa. S Afr J Infect Dis 2016. [DOI: 10.1080/23120053.2015.1118819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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